how to develop a home modification initiative A Community Guidebook

Planning Tools for
Elder-Friendly Communities
www.AgingIndiana.org
how to develop a
home modification
initiative
A Community Guidebook
Deborah McCarty
Philip B. Stafford
Copyright Indiana University 2010
About the Authors:
Deborah McCarty is Director of the Back Home Again in Indiana
Alliance and an Associate of the Center on Aging and Community,
Indiana Institute on Disability and Community. Contact her at
812-855-2150 or [email protected]
Philip B. Stafford is Director of the Center on Aging and Community
at the Indiana Institute on Disability and Community. Contact him
at 812-855-6508 or [email protected] .
PLANNING TOOLS FOR ELDER-FRIENDLY COMMUNITIES
This guide and others in the series are available for free
download at www.agingindiana.org.
Funding for the document was made possible by
the Daniels Fund, Denver, Colorado.
Center on Aging and Community
Indiana Institute on Disability and Community
Indiana’s University Center for Excellence on Disabilities
2853 E. 10th Street
Bloomington, Indiana 47408
812-855-6508
www.iidc.indiana.edu
Cover Illustration:
Layout Design:
Courtesy of Evergreen Institute on Elder Environments, Inc.
Jane Harlan-Simmons
How to Develop a Home Modification Initiative
INTRODUCTION
Many older adults and people with disabilities
lead vibrant lives and have valued roles
including those of family member, friend,
neighbor, employee or employer and community member. People live in their own
homes – either leased or owned - and work and
volunteer in places of their choosing. For
older adults there is abundant evidence that
people prefer to continue to live independently
for as long as possible. Chronic illness and
associated disabilities however can threaten
a person’s ability to continue to live in his or
her own home and community. There are also
older adults who may not have a specific
disability nor do not see themselves as having
a functional impairment but the features of the
environment pose safety risks. For people with
mobility impairments, the home environment
often needs to include universal design features and personalized home modifications to
assure the full and safe use of the home. The
design features of a residence can enable or
jeopardize the fulfillment of a deep wish for
many of us to stay in our own homes for as
long as possible.
In 1990, the Americans with Disability Act
(ADA) established requirements that all new
construction and modifications of public
accommodations (e.g. facilities such as
restaurants, hotels, grocery stores, retails
stores, etc.) must be accessible to individuals
with disabilities. The Fair Housing and
Amendments Act of 1988 (FHAA) outlined
seven accessibility requirements for new
construction of multi-family structures built
after March 13, 1991. Accessibility design thus
began at the level of public accommodations
3
and is currently mandated by federal guidelines
and local municipal building codes for public,
commercial, and multifamily housing. The ADA
does not apply to private residences and most
of the standards would not suit persons in
their homes, where modifications should be
adapted to the unique needs of the person. The
FHAA applies to multi-family structures of four
or more units with some limited exceptions.
It has been about twenty years since the
passage of the ADA and the FHAA. Most of our
private homes, old and new, are still places
where mobility may be significantly impaired
if we become disabled in any capacity,
whether temporary or permanent. The most
common difficulties involve entry into the
house, use of the bathrooms and kitchen, and
moving through doorways and halls. Home
modifications can remedy these structural
barriers, increase safety, minimize the risk of
accidents and support a person’s ability and
desire to remain in his or her home.
Home repair and human service agencies
provide some modifications upon request,
but the older person must generally be aware
of the need to have a specific change made.
Once the need for a modification is identified,
Planning Tools for Elder-Friendly Communities
both older adults and people with disabilities
must often find their way through a labyrinth
to reach the program(s) for which they qualify,
and within which funds and the expertise
needed are available. Contributing to the
level of difficulty experienced by some people
is a housing and social service system that
often runs parallel to one another, with little
exchange of knowledge and coordination of
resources across organizations. The growing
need for home modifications for older adults
and for people with disabilities to remain
in their own homes and communities,
combined with economic realities, creates a
climate of coalition-building potential.
Home Modification as a Strategy for
Aging in Place: Indiana Survey Findings
In 2008, 5,000 Hoosiers age 60 and older were
randomly selected participants in extensive
telephone interviews that assessed the needs
and contributions of older adults to the quality
of life in Indiana. One important area of concern
for many older Hoosiers and their families has
to do with safety and independence in homes
and apartments.
As indicated below in Chart 1, the vast majority of older Hoosiers desire to age in place
in their current residence as long as possible.
Unfortunately, a large percentage of older
Hoosiers are not very confident they will be
able to afford to do so.
4
How to Develop a Home Modification Initiative
In fact, most older Hoosiers intend to make
needed modifications to their homes in the
future, whether that includes basic structural
changes and upkeep or specialized adaptations
such as ramps, bathroom grab bars, lowered
counters, walk-in showers, etc.. Of those with
a need, however, nearly one in five feel they
can’t afford to make the necessary changes.
While structural changes usually require a
major investment, as shown above in Chart 2,
other significant aging-in-place modifications
can be done for a modest cost. Community
financing for these solutions can bring about a
big impact with minimal investment.
5
The survey also revealed that non-white
seniors are twice as likely to need home
modification as white non-Hispanic seniors
(see Chart 3 next page).
Planning Tools for Elder-Friendly Communities
Strategies for Communities
Modifying the home or apartment for safety
and independence can be a key strategy families and communities can develop to help
people age in place.
For example, in Indiana’s Area 14 aging service area (Clark, Floyd, Harrison, and Scott
counties), 590 seniors would make but can’t
afford bathroom modifications. At an average
cost of $500 per household, a community
funding partnership could meet the need
over a five year period through an annual
expenditure of $16,225 dollars per county.
Keeping just one senior per county per year
out of a nursing home for the same period
would save $1.1 million!
Full Survey Data Available
For the complete report of the 2008 Indiana
AdvantAge Initiative survey, visit the project
website at www.agingindiana.org. Various results and demographic reports are provided
for every county in Indiana, and for each
planning and service area associated with
Indiana’s Agencies on Aging.
6
How to Develop a Home Modification Initiative
FORMING A COALITION
FOR HOME MODIFICATIONS
In the mid 1990’s the “First National Conference on Home Modification Policy” was
convened by The Center for Universal Design.
The National Home Modification Coalition was
established, a second conference was held,
and a report was developed.
A Blueprint for Action: A Resource for Promoting Home Modifications was released by
the Center for Universal Design in 1997. Its
intended use is to increase the availability
and affordability of home modifications for
persons of all ages. Particularly important, A
Blueprint for Action articulates an action plan
for promoting home modifications through
coalition building. The National Coalition established a foundation upon which community
and state home modification coalitions can
build.
As the awareness of the benefits of home
modifications and accessible housing increases,
leaders in your community or state may
recognize a need for a collaborative effort
across organizations that share a common goal
for older adults and people with disabilities to
have safe and accessible homes. This booklet
is developed for those who are considering
the potential usefulness of forming a local or
state coalition for home modifications and
accessible housing.
What is a Coalition?
A coalition is an organization of diverse
interest groups that combines their human
and material resources to effect a specific
change the members are unable to bring
about independently. -- Cherie Brown
7
Building a coalition requires individuals and
groups to be willing to join forces with others
for a common goal or mission. It calls for an
identification of shared goals across members,
amidst factors where there is potential or
actual disagreement and lack of unity. It
calls for an understanding of each coalition
member’s agenda and a separation of those
objectives which are compatible from those
that are incompatible with the coalition’s
purpose. The formation of a coalition requires
leadership.
First Steps
Forming a local or state coalition with specific
goals and objectives is an effective way to
increase the availability and affordability of
home modifications. A critical first step is the
presence of an organization(s) willing to lead
the coalition. A small working group can be
formed to share the leadership and initial
costs, and give credibility to the coalition.
Before inviting additional members, this
working group should discuss such questions
as: Who is affected by the issue of home
modifications? Who will benefit from the
coalitions actions? Who has worked on this
Planning Tools for Elder-Friendly Communities
issue in the past? The coalition
organizers should understand other groups’
unique inter-ests and potential contributions.
A group will consider joining a coalition if it is
necessary to reach their goals and if it lacks
sufficient resources to be effective on its own.
There needs to be mutual benefit.
Coalition organizers should consider how each
potential member group could strengthen the
coalition and broaden its base of support.
Resources that members could contribute
include:
• Expertise in home modification, affordable
housing, community organizing, self-
advocacy, fundraising, fair housing, home and community based supports and related
research, etc.;
• Access to a larger constituency groups (e.g., AARP members, Non-profit housing organizations);
• Financial support and funding raising
assistance;
• In-kind contributions (e.g., meeting space,
clerical assistance, volunteers), and;
• Professional and personal relationships
with others with influence and power to effect change.
Throughout the invitation process, the coalition
organizers need to be discerning. All groups
interested in coalition membership do not
need to be extended formal membership. An
organization’s history, image or other feature
may not contribute positively to the public
image and stability of the coalition for home
modifications. There are federally required
opportunities for single organizations and
persons to be engaged in public discussions
on affordable and accessible housing concerns
to which interested parties could be directed.
Coalition organizers can assist such groups in
locating avenues for voicing their positions
and concerns.
“Nothing About Us Without Us”
Coalition organizers are advised to invite a
diverse range of community leaders – not
only the usual suspects or those who meet a
narrow definition of being an expert. People
with disabilities and older adults, some
affiliated with advocacy and community
organizations, are key members of a coalition
for home modifications - Not as recipients
of assistance, but as full contributors to the
coalition building process. Those with personal
experiences with the provision or absence of
home modifications bring the issue alive, with
stories to share, and skills and capabilities to
be exercised.
Coalition organizers will also want to avoid the
possibility that those who are excluded could
become unlikely to embrace or support the
recommendations of the home modifications
effort. Trust with significant stakeholders
needs to be established from the beginning.
The formation of the coalition creates the
unique opportunity for previously marginalized
persons and organizations who share a common problem situation to align. Coalition leaders are advised to secure the membership
of several advocates with disabilities and
older adults who are community leaders. For
example, the steering committee of the Back
Home in Indiana Alliance, an affordable housing
initiative, requires that at least 30% of the
membership consists of people with disabilities,
representing local and state advocacy groups.
Other members include leaders from housing,
financing and disability affiliated organizations.
8
How to Develop a Home Modification Initiative
The disability rights credo, “Nothing about
Us without Us,” is a guiding principle for
community initiatives.
Further Suggestions on Coalition
Membership
Home modification and accessible housing
issues impact a number of stakeholders, including the aging, disability, housing, building,
financing, advocacy, healthcare and medical
communities. A sample of state, local and other
organizations that coalition organizers may
want to consider involving in a home modification initiative include:
Self-Advocacy Groups
• Centers for Independent Living
• Graduates of Leadership Training Courses
• People First Chapters
Senior Action
Housing and Finance
• Builders Association
• City government housing and community
development offices
• Federal Home Loan Banks
• Lenders with Community Reinvestment
Act Officers
• Public Housing Agency
• State Housing Finance Agency
• USDA Rural Development
Nonprofit Community Housing
Development Organizations and/or Trade Associations
• State office of the Civil Rights Commission
9
• State office of the U.S. Department of
Housing and Urban Development
Health and Social Services
• Area Agencies on Aging & Trade
Associations
• ARC of the United States - State Chapters
and local affiliates
• Providers of home and community-based
services
• Rehabilitation Organizations
(e.g., Occupational Therapy)
Specific Constituency Groups and Associations
• AARP
• United Cerebral Palsy and other disabilityspecific organizations
• Civic Organizations
University
• University Centers for Excellence in
Developmental Disabilities
• Schools of Architecture
Planning Tools for Elder-Friendly Communities
The First Meeting for All Potential
Coalition Members
Considerations for Organizations on
Coalition Membership
The location and time of the meeting should
take into account the schedules of all potential
coalition members. An invitation including a
request for participants to advise the meeting
organizers of any accommodations needed
(e.g., note taker, interpreter) is recommended.
All meeting spaces should be accessible
and arranged to facilitate the mobility and
participation of meeting attendees. It is
suggested that light refreshments be served
to extend hospitality and to promote social
interaction. The agenda needs to be developed
to allow time for:
Coalition organizers are advised to ask for
potential members to reflect on several considerations prior to securing a commitment
from an organization. Considerations may include:
• Informal social interaction
• Presentation and discussion of the proposed mission, compelling research or
opportunities, membership criteria, potential roles and activities
• Group discussion
• Decision making on coalition formation and
next steps.
The group assembled for the meeting will
decide if the development of the coalition
will go forward. Once the decision is made to
proceed, coalition organizers may continue
to coordinate needed activities or a planning
committee could be established. The planning
committee can be larger than the group of
coalition organizers.
Finally, potential members can be asked to submit recommendations of others who should
be invited to the next meeting. This can help
the coalition organizers identify potential additional stakeholders unknown to them.
1. Is the issue of sufficient interest and
importance to the organization/person?
2. Are the values and priorities of the
organization/person consistent with that of
the coalition?
3. What potential benefits from membership
are anticipated by the organization/person?
4. What contributions can the organization/
person make to the coalition?
5. Are the coalition’s structures and policies
compatible with those of the organization/
person? For example, can the coalition
decision making process be accepted by the
organization (e.g., consensus required by
those in attendance at meetings, etc.)
6. Home modification coalitions require long
term commitments. Specific actions to be
taken may also include short term objectives
(e.g., conduct two community awareness
events on home safety and modifications),
where the member disengages upon the
completion of the task. Is the organization
interested in a short term or long term
commitment?
Developing a Vision and Action Plan
“If you don’t know where you are going, you
might end up somewhere else.” - Casey Stengel
Visioning is a process by which a coalition may
envision the ideal future. This process can
bring a diverse group together by developing
a shared image of what they want for their
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How to Develop a Home Modification Initiative
community and what they are willing to
work towards. A combination of graphics and
words is suggested when recording coalition
member’s visions for an ideal future. The
aim of visioning is to begin to build sufficient
common understanding and mutual support
across coalition members. The process is often
invigorating for a group.
and is not intended to be exclusionary. Coalition
organizers will find similarities across many
different processes. The cited processes can
be used to “get out of the gate” fairly quickly,
by setting goals that are positive and possible.
It is important to set achievable goals and for
the coalition to experience some early success
in order to build the confidence of group.
Once a coalition has envisioned the ideal,
members will need to articulate the current
reality – what is contributing positively towards
reaching the ideal, and what is creating an
obstruction or barrier? Typically there is substantial tension between the ideal and the
here and now of reality. From this discrepancy
what actions the coalition needs to pursue
begin to emerge. Cherie Brown, Director of
the National Coalition Building Institute (NCBI)
sums this process up by advising a coalition to
consider three questions:
Pearpoint, O’Brien, and Forest, the authors
of PATH (1993) describe the action planning
process as follows: “The problem (of access to
home modifications) is big and complex, but
solutions are more likely to develop a step at
a time, from experience and reflection, than
they are to arrive comprehensively in a flash.
The problem (of a home modification system)
challenges people and their organizations to
learn how to learn by taking action, testing
results and purpose and then taking the next
step.” In short, strategies need to be revised as
more information is collected and circumstances
change. In order to be effective, a coalition
must be flexible to respond to the unforeseen.
1. What is the ideal?
2. What is the reality?
3. How do they differ, and what must be
changed to achieve the ideal?
Answering these questions is the starting
point for the creation and implementation
of an action plan. The kind of actions that
need to be taken may include increasing
awareness and addressing attitudes about
home modifications, may require efforts to
impact policy and influence legislation, and/or
may involve getting involved in the election of
officials.
There are numerous tools available that
describe approaches for visioning and developing strategic plans. A limited list of recommended resources is included in this booklet,
11
As Will Rogers said, “Even if you’re on the right
track, you’ll get run over if you just sit there.”
Coalitions live by their results.
Planning Tools for Elder-Friendly Communities
Identify New Allies
The coalition will find and cultivate other allies
as the work progresses. Key to the success of
a coalition is a focus on relationship building,
certainly first with those who share similar
concerns and values for home modification
efforts. It is also useful to identify those who
disagree with the coalition’s priorities. Cherie
Brown emphasizes however cultivating allies
“somewhere in the middle” where the vast
majority may agree with the coalition’s issue
if further information or encouragement is
offered. When one considers the need for
home modifications and home safety features,
there are few who will not at some point in
their lives (or know someone who will) need
or benefit from these home improvements.
The coalition needs to continue to broaden the
base of support with other organizations and
key persons who can help move the agenda
forward.
Maintaining Commitment
Coalition members will offer varying levels of
commitment of staff, time, money and other
resources. It is therefore important to identify
multiple ways for each to contribute. This
approach often has the benefit of leading to
a greater number of members who find they
can contribute in a meaningful way to a shared
concern. Some simple ways to be involved could
include hosting a coalition meeting, registering
people at a local conference, submitting an
article for a newsletter, facilitating a community
meeting, and arranging for an introduction to
a potential new ally.
Coalitions are primarily comprised of a group of
voluntary relationships formed for a common
mission. Members’ primary affiliation is with
the group with which they are associated.
Remembering this, the coalition leaders need
to consciously strive to maintain the morale
and commitment of the members and support
their affiliated organizations. Newsletters,
packets of relevant information and other
resources can assist the member organizations.
Community meetings and conferences are
positive vehicles for sharing information and
sustaining positive energy. It is important for
the coalition leaders to “give back” as soon as
possible and often for the investments made
by others. Coalition parties or other social
events can strengthen people’s relationships.
And finally it is important to remember to
celebrate large and small achievements, along
the way. A combination of good work, rest and
celebration can boost morale, renew hope and
strengthen the participation of all involved.
HOW THE PROBLEM IS ADDRESSED
IN MANY COMMUNITIES
The need for home modifications and
accessible housing is addressed in a number
of ways in different communities. Private
pay is an option for those who can afford to
renovate their homes. For others, depending
on program eligibility and funding availability,
disability or aging related services, or
affordable housing resources may be used.
The person seeking modifications is often
confronted with a patchwork of various
public and private programs, each requiring
individual applications. Waiting lists are
common for access to home modification
funds for a residence, whether owned or
12
How to Develop a Home Modification Initiative
leased. People in need of accessible housing
are confronted with a limited number of
accessible and affordable units in multi-family
properties. Few units are typically affordable
to those with less than 30% of area median
income or for those who receive Supplemental
Security Income. A summary of some of the
key private and public programs potentially
available to financially assist persons follows.
Reverse Mortgages for Older
Homeowners
A reverse mortgage is a special type of home
loan that enables homeowners 62 years of
age or older to withdraw some of the equity in
their homes. Unlike a traditional home equity
loan or second mortgage, no repayment is
required until the homeowners no longer use
the house as their primary residence. HUD’s
Federal Housing Administration (FHA) created
one of the first reverse mortgages, the Home
Equity Conversion Mortgage (HECM). Many
seniors use it to make home repairs and
modifications, to supplement social security
income, to pay for medical expenses and
more. For more information see www.hud.gov
(Search Reverse Mortgages).
For homeowners interested in seeing if a
reverse mortgage is right for them it is recommended that that they contact the Housing
Counseling Clearinghouse toll free at (800) 5694287 for a list of HUD-approved counseling
agencies and a list of FHA-approved lenders
with their area. Information is also available
through AARP’s toll free (800) 209-8085.
13
Disability and/or Aging Related Home
Modification Supports
Title XIX Home and Community Based
Services Program (aka Medicaid Waivers)
Some waiver program funds may be used for
environmental modifications for those who
lease and own their own homes. A lifetime
cap is typically assigned. To be eligible for
waiver services, the person must meet criteria
required for admission to a long term care
facility, group home or state institution and
must meet the eligibility of the state Medicaid
program. Not all waiver programs offer environmental modifications.
Vocational Rehabilitation Services
Home modifications may be authorized to
facilitate home entry and exit when needed
for a homeowner to access the workplace or
other vocational rehabilitation services provided outside of the home, including modifications to the bedroom, bathroom, kitchen
and garage.
Planning Tools for Elder-Friendly Communities
PUBLIC AND PRIVATE
HOUSING REQUIREMENTS
Section 504 of the Rehabilitation Act of 1973
There are a number of federally funded
housing developments that must meet the
accessibility requirements of Section 504 of
the Rehabilitation Act of 1973 (Section 504).
Section 504 requires that a minimum of 5%
or at least one unit (whichever is greater) of
the housing developed by recipients of federal
funds meet Uniform Federal Accessibility
Standards (UFAS) for people with mobility impairments, and an additional 2% or at least
one unit (whichever is greater) is required for
people with hearing or visual impairments.
The minimum percentage of accessible units
required by Section 504 has not changed since
1973. The U.S. Department of Housing and
Urban Development estimates that about 32%
of residents of HUD funded public housing
residents have disabilities (includes those
without mobility impairments).
Fair Housing Amendments Act of 1988(FHAA)
Most buildings or structures that are intended
for occupancy by one or more families are
covered by the FHAA. Fair housing laws require
100% of new (built after March 13, 1991) multifamily housing with an elevator to meet the
following seven accessibility requirements:
1. Accessible building entrance on an
accessible route.
2. Accessible public and common use areas.
3. Usable doors, sufficiently wide for persons
using wheelchairs
4. Accessible routes into and through the
dwelling unit.
5. Light switches, electrical outlets,
thermostats and other environmental
controls in accessible locations.
6. Reinforced walls in bathroom to allow
later installation of grab bars.
7. Usable kitchens and bathrooms designed
and constructed so a person who uses a
wheelchair can maneuver in the space
provided.
If a building does not have an elevator, all
of the ground floor units in the building
(regardless of the number of units) must meet
the accessibility standards. In rare instances,
sites may have steep terrain or atypical
characteristics that make it impractical for
some units to be made accessible.
The seven FHAA required accessibility features must comply with the design and construction requirements of the American
National Standards Institute (ANSI). The ANSI
A117.1 standard is the technical standard
for the design of housing and other facilities
that are accessible to persons with disabilities
referenced in the FHAA. The ANSI 2003 edition
has been adopted as the current standard,
although requirements cited in the 1986, 1992
and 1998 additions also remain sufficient to
meet FHAA accessibility requirements.
Additional protections under the FHAA require
landlords to make reasonable modifications
or reasonable accommodations upon request.
A tenant may make physical alterations to
the housing unit at his or her own expense,
if needed to make full use of the premises.
The landlord may approve a modification
subject to an agreement that the tenant will
14
How to Develop a Home Modification Initiative
restore the interior to its original condition
before terminating occupancy. The landlord
or leasing agent must also make reasonable
modifications to its rules, policies, procedures
or services so that a person with a disability
has an equal opportunity to use and enjoy a
dwelling (e.g., a building with a “no pets” policy
must allow a person with a visual impairment
to keep a service dog).
A SAMPLE OF AFFORDABLE
AND ACCESSIBLE HOUSING
PROGRAMS AND RESOURCES
U.S. Department of Housing and Urban
Development (HUD)
Most affordable housing programs are
federally funded and are based within HUD.
Several HUD funded housing programs –
such as the HOME Investments Partnership
Program (HOME), Community Development
Block Grant (CDBG) and Section 8 project
based rental assistance can contribute to the
accessible housing stock (owned or leased)
within a community. Housing developed with
HOME and CDBG funds or subsidized with
Section 8 project based rental assistance are
subject to the accessibility requirements of
Section 504 of the Rehabilitation Act of 1973
and FHAA.
HOME
These funds can be used to make home
modifications or repairs, to expand affordable
homeownership opportunities and to build
or renovate rental properties. HOME may
also be used to provide tenant based rental
assistance. It is the largest federal housing
program available to exclusively create new
15
affordable housing. The allocation of funds is
controlled by state or local housing officials.
CDBG
CDBG funds may be used for a wide variety
of housing, community and economic development activities. These funds can be used to
make home modifications or repairs.
On average, states allocate about 25% of
these funds for housing related projects. The
allocation of funds is controlled by state or
local housing officials.
Section 8 Project Based and Section 8
Tenant Based Rental Assistance
As a HUD program, Section 8 housing is one of
the most important federal programs available
to assist people with low incomes. Typically,
the household’s portion of the rent is 30%
of their adjusted monthly income, with the
Section 8 subsidy covering the balance of the
rent and utilities within HUD approved rates.
Section 8 project based housing is a program
where the rental assistance is tied to a specific
building or housing unit. To receive the project
based rental assistance a person or household is
required to live in designated housing. Section
Planning Tools for Elder-Friendly Communities
504 of the Rehabilitation Act
of 1973 requirements assure the construction
of some accessible units that meet UFAS in
Section 8 project based housing.
Another important Section 8 program is
tenant based rental assistance. This allows
the renter to choose housing from the private
rental market or to access other publicly
funded housing (e.g., low income housing tax
credit developments) that would otherwise
not be affordable. Housing from the private
rental housing market must comply with the
requirements of FHAA. A person with tenant
based rental assistance can choose where
to live and may be able to locate accessible
housing or make needed modifications to
housing in the private market.
The Section 8 programs are administered by
local Public Housing Agencies (also known
as Public Housing Authorities or PHAs)
under a contract with HUD. State agencies
may also serve as a designated state agency
responsible for administering Section 8 tenant
based vouchers. Public Housing Agencies are
to assist a person locate an accessible rental
when needed.
Section 202 Supportive Housing for the
Elderly
The Section 202 Supportive Housing for the
Elderly program provides capital advances
and project rental assistance under Section
202 of the Housing Act of 1959 (as amended)
for housing projects serving older adult
households. Section 504 of the Rehabilitation
Act of 1973 requirements assure the construction of some accessible units that meet
UFAS in Section 8 project based housing.
U.S. Department of Agriculture-Rural
Development (Rural Development)
There are two main sources of federal funding
for affordable housing in rural communities:
HUD and U.S. Department of Agriculture- Rural
Development (Rural Development). Rural
Development funds are used exclusively in rural
communities and are valuable resources for
home renovations and repairs (including home
modifications), rental assistance programs and
homeownership opportunities. The following two Rural Development programs may be
of particular interest to a coalition for home
modifications and accessible housing.
Rural Development: Housing Home
Repair Loan and Grant Programs
(Rural Development Section 504)
Rural Development Section 504 provides 1
percent loans to very-low income (below
50% of area medium income) homeowners
to make essential repairs or rehabilitation to
their homes. Grants up to $7,500 for essential
repairs, including home modifications are
available to homeowners who are elderly and
who cannot afford a 1 percent loan.
Rural Development: Rental Assistance
Program (Section 521)
Section 521 provides rental assistance to
some tenants with low incomes who are living
in affordable rural rental housing developed
through the Rural Rental Housing Program:
Direct Loans (Section 515). The rental subsidy
is project based assistance. Section 504 of
the Rehabilitation Act of 1973 guides the
development of accessible units in these
properties.
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How to Develop a Home Modification Initiative
Low Income Housing Tax Credit Program
Finally, the Low Income Housing Tax Credit
Program (LIHTC), managed by the Department
of Treasury’s Internal Revenue Service (IRS), is
currently the largest source of federal subsidy
for new or rehabilitated rental housing in
the U.S. The LIHTC is administered through
a state’s housing finance agency. When the
LIHTC Program is matched with other federal
funding, such as HOME and CDBG, the housing
development is subject to the requirements of
Section 504 of the Rehabilitation Act of 1973
for accessible housing.
A barrier is that few LIHTC programs have
developed housing that is affordable to people
with incomes that are about twenty percent
(20%) of area medium income. As a result,
people with disabilities with Supplemental
Security Income (SSI) often cannot afford to
rent an accessible LIHTC unit. Other rental
subsidies like Section 8 or HOME tenant based
rental assistance must be in place for the unit
to be affordable. Pennsylvania has addressed
this barrier by providing incentives to developers using the LIHTC program to create both
more accessible units and to make these units
affordable to people with disabilities with twenty
percent (20%) area median income or less.
17
COLLECTING HOME MODIFICATION
AND ACCESSIBLE HOUSING
INFORMATION
Using the above listing of housing programs,
resources and accessibility requirements as
a springboard, it is recommended that the
coalition leaders collect information on the
available accessible rental housing in the
geographic area of focus. Information that
would be helpful for a coalition to collect is
the number of accessible units, their bedroom
sizes and the percentage of area medium
income (AMI) for which each accessible unit is
affordable. The AMI and income limits for each
geographic area is published annually by HUD
(see www.huduser.org. Select, Income Limits).
Finally it is recommended that the coalition
determine if people needing accessible
features are living in the accessible units.
Second, it is recommended that the coalition
leaders assemble information on how the
HOME, CDBG, and Rural Development (if
the area included is rural) funds have been
spent – for which programs (home repairs and
modifications; homeownership, affordable
rentals) and the income levels (e.g., percentage
of area medium income) of beneficiaries. In
Planning Tools for Elder-Friendly Communities
Indiana, housing rehabilitation
funding sources of federal origin were found
to be significantly underutilized for specialized
home modification services (Stafford and
Harlan-Simmons, 2003). In contrast in Philadelphia County in Pennsylvania, about two
million in CDBG funds have been dedicated to
a home modification and repair initiative for
older adults and people with disabilities.
Information on the use of Medicaid waivers,
Vocational Rehabilitation services and private
sources of assistance (e.g., Habitat for Humanity, Rebuilding Together’s Safe at Home program) for home modifications in the coalition’s geographic area could also be helpful in
planning. Information compiled on the needs
for home modifications and the existing
barriers experienced (e.g., waiting lists) is important to defining and solving the problem.
Conducting this research may be both an early
and ongoing action taken by coalition leaders.
AFFORDABLE HOUSING PRIORITIES
AND PUBLIC PARTICIPATION
OPPORTUNITIES
Once the coalition leaders have conducted
some basic research on home modification,
accessible housing needs and expenditures
across both the social service and affordable
housing programs, the stage is set for
involvement in the development of local and
state housing plans. It is recommended that
the coalition and its allies become involved
in the public participation opportunities that
are required by HUD and the Department of
Treasury/IRS as a part of the coalition’s action
plan. This will help assure the representation
of the coalition’s issues in important public
policy arenas. Two plans are emphasized here
– the Consolidated Plan and the Qualified
Allocation Plan.
The Five Year Consolidated Plan (ConPlan)
This is the document submitted to HUD that
serves as the planning guide for entitlements
funded under the Community Planning and
Development formula for the Community
Development Block Grant (CDBG) and HOME
grant programs. The ConPlan provides an
assessment of the housing and community
development needs; a strategic plan for
addressing these needs; and a specific one
year Action Plan for the use of HUD grants
funds. This plan is submitted to HUD to project
and define the comprehensive affordable
housing strategy and community development
needs for defined geographic areas in a state.
All communities have a ConPlan that guides
the use of HOME and CDBG funds that are
potentially available for their area.
Key to the development of the ConPlan is the
HUD requirement for public participation,
including the holding of public hearings
and the inclusion of correspondence from
constituents in the plan. Coalition members
and allies can organize and work to assure
the sharing of research findings and personal
stories about the need for accessible housing
and the benefits of home modifications.
Personal contact between constituents and
policymakers and the sharing of stories can be
a strong catalyst for change.
The Qualified Allocations Plan
The IRS requires state housing agencies, the
administrators of the Low Income Housing
Tax Credit program, to develop a Qualified
Allocations Plan (QAP). The QAP is a federally
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How to Develop a Home Modification Initiative
mandated planning requirement that states
use to explain the criteria used to distribute
their federal LIHTC allocation. Based on their
QAP, states can establish preferences and setasides to target resources towards specific
places (rural communities) or populations (such
as older adults or people with disabilities). The
QAP is developed annually and public participation is required. In Pennsylvania, disability
advocates worked effectively with the state
housing finance agency to include incentives
for the development of twice as many fully
accessible units as are otherwise required
(under local, state, or federal mandate, whichever is greater). In addition, incentives are in
place for developers who submit a financing
plan ensuring that accessible units in the
housing development will be affordable to
persons at or below twenty (20) percent of the
area median income, adjusted for family size.
HOW THE PROBLEM IS
SUCCESSFULLY ADDRESSED IN
SOME COMMUNITIES
The National Resource Center on Supportive
Housing and Home Modification (NRCSHHM)
is a University of Southern California-based,
non-profit organization whose mission is to
promote aging in place and independent
living for persons of all ages and abilities. It
serves as an information clearinghouse on
home modifications and provides training
and education to respond to the increasing
demand for home modifications. In 2001
NRCSHHM conducted a survey of home
modification programs throughout the U.S.
Several programs were then selected as
exemplary models of service including both
organizations that formed coalitions and those
19
that managed a home modification program
internally. A summary of three programs that
were selected as exemplary models of services
is summarized below.
Pennsylvania Initiatives
Two of the nationally recognized home modification programs are based in Philadelphia
Pennsylvania. One program is designed to
address the needs of older adults and is
located in the Philadelphia Corporation on
Aging (PCA), an Area Agency on Aging for
Philadelphia County. The second program is
designed to meet the home modification
needs of people with physical disabilities and
is administered by the Philadelphia Housing
Development Corporation (PHDC).
Senior Housing Assistance Repair Program
PCA operates a Senior Housing Assistance
Repair Program (SHARP) that performs minor
repairs and modifications for homeowners
ages 60 years and older who meet financial
eligibility criteria (household incomes must
be at or below 150% of poverty). Home
modifications may include safety and security
measures, basic repairs and modifications that
maximize the independence of the home-
Planning Tools for Elder-Friendly Communities
owner and ease caregiving.
Since 1987 hundreds of homes have received
major adaptations (e.g., stair glides) and thousands of homes have received minor adaptations (e.g., replacing stair railings).Bathroom
modifications are a common need and are
considered a high priority. Major modifications
are limited to those who live alone with no
consistent support.
In 2009, a budget of 1.6 million assisted
700 households. The 2009 budget included
$325,000 in CDBG funds combined with
Pennsylvania Lottery funds channeled through
the Pennsylvania Department of Aging. SHARP
operates a waiting list and in 2010 the average
wait was about 6 months.
PCA’s program strength was noted in its
intra-agency coordination. Within its housing
department, coordination between the Occupational Therapist (OT), and the construction
staff was found to be an essential ingredient.
This coordination in combination with communicating well with the homeowner leads to
successfully implementing modi-fications that
will be used to the fullest extent. The 2010 PCA
Housing Director reinforced the importance
of involving an OT in the planning process for
seniors in frail health and for others interested
in the assistance.
Adaptive Modification Program
The Adaptive Modification Program (AMP)
provides free major modifications, such as
accessible kitchens and bathrooms, stairway
elevators, exterior wheelchair lifts and ramps,
and widened doorways for eligible homeowners and renters with disabilities. The purpose of AMP is to assist persons with physical
disabilities to live independently in their own
homes and avoid institutionalization. The
program was originally administered through
the Philadelphia Corporation on Aging and is
now operated by the Philadelphia Housing
Development Corporation, a full service housing developer that works with the City of Philadelphia. Since 2001 the budget has ranged
between $1.5 and $5 million in CDBG funds.
The 2010 budget is 1.5 million. Given the
demand, applicants may wait several years for
participation in the program.
California’s Santa Clarita Valley
Commission on Aging
The Santa Clarita Valley Commission on Aging
(SCVCoA), a not-for-profit organization was
formed as a grass roots effort in response
to the growing needs of older persons living
within the community. Home modifications
emerged as an extension of the Handyworker
program, a free home repair and rehabilitation
program for homeowners and renters with low
to moderate incomes. Home modifications
are available for seniors and adults with
disabilities.
Within its community SCVCoA surfaced as a
leader in home modification capacity building,
by becoming the steering organization for
a local coalition, known as the Santa Clarita
Home Modification Coalition. The coalition
brought together the building industry including remodelers, builders, and suppliers
with social workers, caregivers, and other
agency representatives within the community
to provide home improvements. The coalition
planned activities for consumers, service
delivery professionals, public decision makers,
and the corporate sector. It has acted as a
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How to Develop a Home Modification Initiative
means by which to increase community
awareness of the services for home modifications already in existence. SCVCoA has used
the coalition to create and enhance public and
private collaboration.
In 1999 the coalition partnered with the
Andrus Gerontology Center, University of
Southern California and the Pasadena Home
Modification to construct two interactive
home modification exhibits in easily accessible
community locations. The purpose was to
demonstrate to the public and to professionals
the effectiveness of universal design and
home modifications in ensuring a safe, comfortable and accessible dwelling. Over a two
month period, about 5,000 persons visited
the exhibits. In evaluations, over 80% of the
visitors indicated that their knowledge of
home modifications was substantially increased and nearly half reported that they
would be making a change to their home, or
to the home of someone they knew, as a result
of this information.
Linton, Indiana: A Naturally Occurring
Retirement Community
Outside of the east and west coast home
modification programs recognized in the 2001
awards, the small midwestern community
of Linton, Indiana supports a home safety,
physical wellness and transportation initiative
for seniors. The overall intent is to improve
the mobility of seniors living in an area of
town identified by aging professionals as a
Naturally Occurring Retirement Community
(NORC). A NORC, is a community where a large
concentration of older adults have chosen to
remain over their lifetime, be it a high rise in a
big city or, as in this instance, a neighborhood
21
of single family homes in a small town in a
rural county.
The home safety project was originally made
possible by funding through the Indiana
Division of Aging, technical assistance from the
University of Indianapolis’s Center for Aging
and Community , the Indiana University Center
on Aging and Community, and coordination
from Generations, the Area Agency on Aging
(AAA). Key to the design of the initiative is the
100% resident led Steering Committee and an
Advisory Committee comprised of community
businesses and partners. In 2009, these committees identified home modifications as
the priority for the use of $25,000 in project
funds. The financial result - the cost of modifications averaged about $1000 to $3000 per
household with a couple being more extensive
and a few being more minor. Examples of
modifications included building ramps, installing shower bars, installing raised toilets,
replacing flooring, purchasing shower chairs
and improving lighting.
And what was the response of the homeowners? One homeowner captures the voice
of many who found increased confidence
and ease in mobility as a result of the home
Planning Tools for Elder-Friendly Communities
adaptations. “The thought of
needing a ramp floored me!” The homeowner
was aware that she had trouble with steps but
never thought of needing a ramp at her garage
entrance to her kitchen. She would set her
shopping bags inside the door while still in the
garage and then when all bags were inside,
she would struggle up the stairs into the home
and then have to bend over to pick up all the
bags. She has been amazed at how helpful the
ramp is not only to her but also to her friends
who visit. Concerning the grab bars in the tub
she said, “I didn’t realize how unsure of myself
I was before the bars were installed, but I now
have so much more security getting in and out
of the tub.”
Additional funding is being sought through
state and federal affordable housing rehabilitation and modification programs, including
USDA Rural Development and the State
Community Development Block Grant to expand the home safety and modification initiate
beyond one neighborhood to across town.
Linton is a town where there is an investment
in residents who want to “stay put” in their
homes and are age 60 or older.
SUMMARY
The number of people who can benefit from
home modifications and accessible housing
grows each year and is not expected to peak
until about 2050. Simultaneously, housing
constructed with public and private funds
are not creating many newly built universally
designed or accessible residential units to meet
the growing needs of people of all ages. This
tide can be turned through the establishment
of a home modification coalition. Bringing
together older adults, advocates from the
physical disability community, members of
the housing and financing industry, and health
and human service professionals to increase
the availability and affordability of accessible
housing (both rental and owned) for persons
of all ages is an effective community organizing
strategy. Efforts of a coalition can be directed
to modify existing housing and to assure that
new housing constructed with federal funds is
designed to be usable by all.
A home modification coalition does not have to
start from scratch. A solid foundation has been
laid by the National Coalition for Home Modifications. A Blueprint for Action: A Resource for
Promoting Home Modifications articulates an
action plan for promoting home modifications
through coalition building that can be adapted to meet local and state priorities.
Every community is the potential recipient
of federal financed affordable housing funds.
Existing state and/or local plans with articulated housing needs and intended funding
allocations are in place now and are required
to be annually updated. If people’s homes and
your community’s housing stock could benefit
from modifications and repairs, and multifamily units that are accessible to all, consider
working with others with a shared concern
and mission. A coalition’s participation in the
development of its HUD required Consolidated
Plan and the IRS required State Qualified
Allocation Plan can help shape the annual
allocations of millions of affordable housing
funds. Potential millions to support the simple
notion of living in one’s home and community
as long as possible, safely and comfortably.
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How to Develop a Home Modification Initiative
REFERENCES
A Blueprint for Action: A Resource for Promoting Home Modifications. 1997. Raleigh, NC:
The Center of Universal Design, North Carolina
State University.
Stafford, P.B. (2003). FACT SHEET: Home
Modification Resource List. Bloomington, IN:
Indiana University. Ames, S., (Ed.). 1998. A Guide to Community
Visioning: Hands-On Information for Local
Communities. Portland, OR: Oregon Visions
Project.
Stafford, P.B. & Harlan-Simmons, J. (2003).
Home Modification Services in Indiana: Statewide Survey Results and Recommendations for
Public Policy and Programs. Bloomington, IN.
Indiana University.
Brown, C. R. (1984). The Art of Coalition
Building. A Guide for Community Leaders. New
York, NY: The American Jewish Committee.
Kenley, M. & McCarty, D. (2003). A Place
to Call Home. Strategies for Affordable and
Accessible Housing. Booklet Four: Fair Housing.
Bloomington, IN: Indiana University.
Kretzmann, J. P. & McKnight, John. (1993).
Building Communities from the Inside Out:
A Path Toward Finding and Mobilizing a
Community’s Assets. Chicago, IL: ACTA Publications.
Pearpoint, J., O’Brien, J., Forest, M. (1993).
PATH: Planning Alternative Tomorrows with
Hope. A Workbook for Planning Possible Positive Futures. Toronto, Canada: Inclusion Press.
Regnier, V. & Pynoos, J. (Eds.). (1987). Housing
the Aged. Design Directives and Policy Considerations. New York, NY: Elsevier.
Sarkissian, W., Hofer, N., Shore, Y., Vajda, S.,
Wilkinson, C. (2009). Kitchen Table Sustainability. Practical Recipes for Community Engagement with Sustainability. Sterling, VA:
Earthscan.
Stafford, P.B. (2009) Elderburbia: Aging with
a Sense of Place in America. Santa Barbara:
Praeger.
23
The Community Collaboration Manual (1993).
Washington, DC: The National Assembly of
National Voluntary Health and Social Welfare
Organizations.
Planning Tools for Elder-Friendly Communities
RESOURCES
Center for Universal Design
Safety standards, accessibility guidelines,
products and services, and many more
resources relating to universal design.
http://www.design.ncsu.edu/cud
Concrete Change
This organization has launched an international campaign to make virtually all
homes visitable (accessible to all) by providing the most essential features. Download free powerpoint presentations.
http://www.concretechange.org
Directory of Centers for Independent Living
Click on your state for the nearest CIL.
http://www.virtualcil.net/cils
Fair Housing Accessibility FIRST
An initiative designed to promote compliance with the Fair Housing Act design and
construction requirements. The program
offers comprehensive and detailed instruction programs, useful online web resources,
and a toll-free information line for technical guidance and support.
http://www.fairhousingfirst.org
Generations, Inc.
Indiana Area Agency on Aging that serves rural
counties and coordinated a Naturally Occurring
Retirement Community home safety program.
www.generationsnetwork.org
HomeMods.org
This site provides information on home modification topics from finding home modification contractors to searching for specific
products that improve home accessibility.
Online courses are available. Videos are
listed for purchase. You can download a copy
of A Blueprint for Action: A Resource for Promoting Home Modifications. 1997. Raleigh,
NC: The Center of Universal Design, North
Carolina State University.
http://www.homemods.org
Independent Living Research Utilization
(ILRU) A national center for information,
training, research, and technical assistance
in independent living.
http://www.ilru.org
Infinite Potential Through Assistive
Technology (Infinitec)
This site is a joint effort of the United Cerebral
Palsy Association of Greater Chicago and
United Cerebral Palsy Associations, Inc.
of Washington, DC. It includes a section
on ways to pay for modifications and a
list of other websites that address home
modification and universal design. http://www.infinitec.org
National Coalition Building Institute (NCBI)
A nonprofit leadership training organization
based in Washington, D.C. Since 1984, NCBI
has been working to eliminate prejudice
and inter-group conflict in communities
throughout the world.
http://www.ncbi.org
National Resource Center on Supportive
Housing and Home Modification (NRCSHHM)
A University of California based center
whose mission is to make supportive housing
and home modification a more integral
component of successful aging, long-term
care, preventive health, and the development
of elder-friendly communities. NRCSHHM
serves as a lead organizations for the National
Home Modifications Action Coalition.
http://www.usc.edu/dept/gero/nrcshhm/
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How to Develop a Home Modification Initiative
NORC Blueprint: Naturally Occurring
Retirement Community
The NORC program model has emerged and
grown over the past 20 years. While NORC
programs originated in New York City they
can now be found in communities in 24
other states. The NNORC website – NORC
Blueprint – provides guidelines for designing
and managing high quality programs to
serve seniors and their communities.
tional priority. Since 1942, NAHB has been
serving the housing industry and the public.
http://www.nahb.org
Scott, B. (1998). Planning accessible meetings:
a guide to ADA compliance. Washington, DC:
American Society of Association Executives.
The ASSIST Guidebook to the
Accessible Home: Practical Designs for
http://www.norcblueprint.org/norc
Home Modifications and New Construction.
2005. Salt Lake City, Utah: ASSIST, Inc.
National Directory of Home Modification
Resources (NRCSHHM)
U.S. Department of Housing and Urban
Development
A listing of home modifications resources is
provided by state.
http://www.usc.edu/dept/gero/nrcshhm/directory/
Peters, R. (2009). Practical Improvements for
Older Homeowners. Easy Ways to Make Your
Home More Comfortable as You Age. New
York, NY: Hearst Books.
Philadelphia Corporation for Aging
Programs and Resources for Seniors in Pennsylvania. The Housing Department administers a nationally recognized home modification and repair program for seniors.
http://www.pcacares.org
Philadelphia Housing Development Corp.
A full service housing developer that works
with the City of Philadelphia and administers the nationally recognized Adaptive
Modifications Program (AMP).
http://www.phdchousing.org
Remodelers Council, National Association
of Homebuilders (search on accessibility)
NAHB is a trade association that helps promote the policies that make housing a na25
Learn about renting, buying and making your
home accessible, and about your Fair Housing
rights. http://www.hud.gov
Planning Tools for Elder-Friendly Communities
DEFINITION OF TERMS
Accessibility
Accessibility defines environments which
are safe and usable by people of all ages and
abilities. Design and construction requirements for accessibility are specified in the Fair
Housing Act Amendments and the Uniform
Federal Accessibility Standards.
(Source: U.S. Department of Housing and Urban Development)
Home Modification
Home modifications are adaptations to one’s
living environment that are designed to make
tasks easier, reduce accidents, and support
independent living. Examples include removing
hazards, adding special features (e.g. ramps) or
assistive devices, moving furnishings, changing
how activities are carried out or where they
occur, and structural renovations.
(Source: National Resource Center on Supportive Housing and Home Modification)
Naturally Occurring Retirement
Community (NORC)
Universal Design
Universal design is design of products and
environments to be usable by all people, to
the greatest extent possible, without the
need for adaptation or specialized design.
(Source: Center for Universal Design,
University of North Carolina)
Visitability
A visitable home is one that is built on the
open market, not specifically for people with
disabilities, with a few specific access features.
The three essential access features of a
visitable home are:
• one zero-step entrance, at the front, back or side of the house with an accessiblle
route;
• all main floor doors with at least 32 inches
of clear passage space;
• at least a half bath, preferably a full bath,
on the main floor.
(Source: Concrete Change)
NORC is a demographic term coined in 1985
used to describe a community that was not
originally built for seniors where a significant
proportion (40%) of its residents are over the
age of 60.
(Source: NY Division of Aging)
26